Anterior cruciate ligament (ACL) re-construction techniques are applied to an increased number of re-construction operations. The ovoid morphology of the native tibial and femoral ACL attachment areas results in the ACL having a continuum of fibers whose length and tension changes differently with knee flexion.
Anteromedial (AM) bundle fibers have been shown to undergo small length changes from full extension to 90 degrees of flexion, whereas posterolateral (PL) bundle fibers demonstrate large changes in length from full extension to 90 degrees of flexion. The anteromedial and posterolateral bundles act synergistically to retrain anterior laxity through the range of knee flexion.
However, many surgeons have been reluctant to adopt double-bundle re-construction, citing concerns about accurate placement of multiple bone tunnels and femoral condoyle fracture as a result of weakness induced by multiple tunnels.